Brainstorm Health: Medicaid Work Requirements, FDA and Social Media, Humana Leaves AHIP

The Trump administration is paving the way for one of the biggest policy changes to U.S. Health care in decades. For the first time ever, the administration is giving states the green light to seek waivers that would allow them to impose work or job training requirements on people who rely on Medicaid, the federal-state partnership program which provides largely free health care coverage to more than 70 million children, low-income Americans, the disabled, and the elderly.

The new regulations’ supporters argue that it’s a common sense idea. If you’re “able-bodied,” the logic goes, you shouldn’t be able to access a free health care program if you don’t have a job and help pay into the public system that subsidizes such coverage. But critics of the historic shift argue that the issue is far more complicated, and that if states do adopt the work requirements, millions of needy people’s Medicaid coverage will be disrupted.

One critical issue that will affect the fallout from the Medicaid work requirements is the makeup of the Medicaid program itself, the critics say. Medicaid is pretty different from even other government health care programs; its beneficiaries are the poorest people in America, kids, and people with disabilities—a coalition of Americans who often have the most difficult health care needs in the country compared with the employer-sponsored private health market.

States wouldn’t be able to request work requirements for disabled people and children under the new guidance; however, a number of nonpartisan health care think tanks point out that many Americans who rely on Medicaid cannot work because they are the primary care providers for much sicker family members or live with other socioeconomic realities that make finding work more difficult. In fact, “[a]mong the adult Medicaid enrollees who were not working, most report major impediments to their ability to work including illness or disability or care-giving responsibilities,” according to the independent Kaiser Family Foundation. About 80% of Medicaid enrollees under the age of 65 are already in working families; part of the reason is Obamacare’s optional Medicaid expansion for working poor adults who don’t have children (prior to the expansion, you often had to be poor and have kids in order to qualify for Medicaid).

As for the others? “[M]ore than one-third of Medicaid beneficiaries who aren’t working report that illness or a disability is the main reason, 28 percent report that they’re taking care of home or family, and 18 percent are in school,” reports the Center of Budget and Policy Priorities.

It’s unclear which states will be the first to pursue a first-of-its-kind Medicaid work requirement waiver. But, if the critics are correct, implementing such a policy could carry some unintended consequences.

Read on for the day’s news.

DIGITAL HEALTH

FDA communications in the social media era.  A new study attempts to gauge the implications and impact of Food and Drug Administration (FDA) drug safety warnings issued via social media. The results were, well, a bit mixed: "Social media offers challenges and opportunities for dissemination of the [drug safety communications (DSC)] messages. The FDA could consider strategies for more actively disseminating DSC safety information through social media platforms, particularly when announcements require updating," wrote the study authors. "The FDA may also benefit from directly contributing content to websites like Wikipedia that are frequently accessed for drug-related information."

Two new studies challenge the conventional wisdom on IVF.  Two large studies by Vietnamese and Chinese researchers suggests that, for many women, thawed embryos and fresh embryos are equally viable options when it comes to in-vitro fertilization. For years, doctors have acted on the assumption that the frozen (and then thawed) embryo is the proper route—but that may not be the case for women without a certain condition, according to the new papers. (Reuters)

INDICATIONS

Endo receives a grand jury subpoena over opioids. Generic drug giant Endo has been issued a grand jury subpoena related to its opioid painkiller oxymorphone, Reuters reports. This is the latest example of state and federal crackdowns on drug companies that manufacture potentially addictive painkillers, scrutinizing marketing practices and safety oversight in particular. (Reuters)

THE BIG PICTURE

Humana latest insurer to leave AHIP trade organization. Humana makes it a hat trick! The insurance giant is the third major company to ditch America's Health Insurance Plans (AHIP), the industry's main trade organization. Other recent, prominent defectors include Aetna and UnitedHealth (the latter is the country's largest private insurer). Just what does that mean? In part, the changing landscape could free individual companies from the political hassles of being lumped into one gigantic industry force (especially as vertical mergers rise in the health care space). (The Hill)

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One Gym Chain Is Banning Cable News Because It's Unhealthy, by Emily Price

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